Permit CITY O F T I G A R D ELECTRICAL PERMIT -
RESTRICTED ENERGY
�'�re�lik DEVELOPMENT H BMENT r S O ERV SERVICES 639 -4171 DATE ISSUED: ED: 1 %8 2004
SITE ADDRESS: 11626 SW PACIFIC HWY PARCEL: 1S136DC -00500
SUBDIVISION: ZONING: C -G
BLOCK: LOT: JURISDICTION: TIG
Project Description: Data cabling.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: CLOCK: MEDICAL:
HVAC: DATA/TELE COMM: X NURSE CALLS:
VACUUM SYSTEM: FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: : HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS: 1
Owner: Contractor:
REGAL CINEMAS LAKE ELECTRONIC CONTRACTORS
BY ACT III LEC SOUND + COMMUNICATIONS
7132 COMMERCIAL PARK DR PO BOX 1550
KNOXVILLE, TN 37918 TUALTIN, OR 97063
Phone: 503- 684 -6348 Phone: 503- 234 -3044
Reg #: MET 00002634
LIC 65381
ELE 3- 165CLE
FEES SUP agi i1i4d Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 11/8/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 11/8/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you t• • • -- -s adopted by the Oregon Utility Notification Center. Those rules are set fort / in OAR 952 - 001 -0010
th • ugh OAR 952-16 -0100. You may obtain copies of these rules or direct questions to 0 - C at (503) 246 -6699.
Is ued by /it f,i! Permittee Signaturek ` ,,
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit Application FOR OFFICE USE ONLY
City of Tigard Received ,
Date/B : i / Permit No.: g, 5 5 .- -
13125 SW Hall Blvd., Tigard, OR 97223 Plan Review
Phone: 503.639.4171 Fax: 503.598.1960 /411114
4 '° . .V1111- Date/B : Other Permit:
.4
Inspection Line: 503.639.4175 Date Ready/By: Ffl See Page 2 for
Internet: www.ci.tigard.or.us Notified/Method: IE9 Supplemental Information
' - ' 4-, '-. t 1.k.-' - '-- •& , ,...1.-' , !'l ',4- - -:; - .,,,":.-A ,, ,i...4.: ' - ,.--, 'Po .'" ..',- • 1.... ,...,.4it., • --,,*,--'' ,:--, 44: i. i - - . " - • .
1 1g,'s.; , .0Y , IliPik..is..: , , At - ilotimol.gv.-;.:,..., - .,,Vai', : -4.E.Y-ACW:4::!::'-'-
El New construction 0 Addition/alteration/replacement Please check all that apply:
0
0Service over 225 amps, comm'I 0Hazardous location
Demolition 0 Other:
. , ., ,. 0Service over 320 amps - rating 0Buildng over 10,000 sq. ft.,
, ..,A; ,..., , ;,,,,,,,, , , , _,•11, -I.. -4,.. , , ,,1 -_ ..;;'-:- , 3 -- : - ' " 7,, t ...:,-'t • 174.6t41,Iskep,pAlt
t..fl 2 , fiqq . ...90Wfillf ..-c91§TRWr:K06.--s*s.x.1,,-.,--...71:,,"4: of 1- and 2-family dwellings 4 or more new residential
0 1- and 2-family dwelling ‘gCommercial/industrial El Accessory building ['System over 600 volts nominal units in one structure
0Building over three stories OFeeders, 400 amps or more
0 Multi 0 Master builder 0 Other:
, . I:Occupant load over 99 persons 0Manufactured structures or
y:,;,V;i:::4iza,....-1**,..'140_,. ,ii.M... fi LT:ii t.rEf....g':8S,t''...'ftf:„.,t 0Egress/lighting plan RV park
0Health-care facility 00ther:
Job no.: Job site address: /j/ 26 S et) a ).6
Submit 2 sets of plans with any of the above.
City/State/ZIP: I i q a ,v a t 1 d p__ et 7 2-7 The above are not applicable to temporary construction service.
4tArig*;'? '-::...:, ' . ': • ''
Suite/bldg./apt. no.: Firoject name: 77 ?. 7,4 C,vegii .7 S Description I Qty. 1 F 2: ee, I Total 1 **
Cross street/directions to job site: New residential single- or multi-family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision: Lot no.: Ea. add'l 500 sq. ft. or portion 33.40 • 1
Limited energy, residential 75.00 2
Tax map/parcel no.:
Limited energy, non-residential 75.00 • 2
' 0 Each manufactured or modular
N dwelling, service and/or feeder _ 90.90 2
D C--(T-At /1 Al' --- B b '4 0
r Zec(i, 4t e ( Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
I:1 ,-... - ...;. - - •-i ; ,•-• • - - - ` - PROBERTY OWNER - 0 TENANT ..• '. 1 ,,•-,,,^ • ■•;;" " ; •- r: 3• 1 • , ' • , - ; • - _3-V. amps 201 to 400 amps 106.85 2
- ` 7 ''-' -'•-•-;' -. : '' ' =' •• ''''''' -1 -' ' - - " -:- '
- 401 amps to 600 arnps 160.60 2
Name: al 6 4rd-14.9 601 amps to 1,000 amps 240.60 2
454.65 2
i r Over 1,000 amps volts Address: -- i 1 2 c ...0 1 , 4 frt p & / P24.-3(. or vol
• Reconnect only 66.85 2
City/State/ZIP: i L ui 1 If r 31 q 1? Temporary services or feeders installation, alteration, and/or
relocation
Phone: (505) t - c Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
for branch c
t A F
t-4-1, $ - , ^■=1*',.../..\,:7,:,0.4....- i",;..il'A.I< :' ,.. ee circuits with
sY• E-Irc • rr4eywt- • .
service or feedeT fee each
i
Business name: L a. -k-e E. lee ( ro i..:: v t 4 4,771,7ti branch circuit , 6.65 2
B. Fee for branch circuits
Contact name: e m e - - 15 i i it without service or feeder fee,
46.85 2
each branch circuit
Address: , i'(, )C / SLS Each add'I branch circuit 6.65 2
City/State/ZIP: 1 4' 1. 69 77 Miscellaneous (service or feeder not included)
Pump or irrigation circle
Phone: (528 ) ... 3Li - 30 4 Fax: : (03 ) 23 tf.,....301_t_ 3 53.40 2
■ Sign or outline lighting 53.40 2
E-mail: .S cffit; ij (:, l-ec-oat_ , 6.0 ii Signal circuit(s) or limited- i
ijilbi ,: L'::-,i -;:::;„,. j - ,.{ 1-...A: f . , :::; , '-_7,1"e0 ,- ,2: 71 :i4 3 . 1 4t, energy panel, alteration, or '725°
- j) i -1- ::- ' ' " ' ' ' ''' extension. Describe: Page 2 2
Business name: L z IC O 1 C Ce IV lir e r S.
Address: N e 0 , 4 (S.,..c1) Each additional inspection over allowable in any of the above
Per inspection 62.50
-
City/State/ZIP: / (j a_l kt A i . ae- / 9 7 06 Investigation per hour (1 hr min) 62.50
t .
Phone: ( ) Fax: ( ) Industrial plant per hour 73.75
i'll; atztaxi:::tOtiopOks
CCB Lic.: (055S 1 Electrical Lic ..
Suprv. Lic.: --r5 Subtotal 35
- I (,:,-- A .
Suprv. Electrician signature, required: Plan review (25% of permit fee) ,
Print name: S ''' .i ( ( Date: ' i zcoll State surcharge (8% of permit fee)
TOTAL PERIVT1T FEE c3 1 . d 0
Authorized signature: This permit application expires if a permit Is not obtained within 180
days after it has been accepted as complete
Print name: Date: • Fee methodology set by Tri-County Building Industry Service Board
" Number of inspections per permit allowed.
i: \Building Termits1ELC-PerrnitApp.doc 12/03 4.40,1615T(10/02/COWWEB
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information •-
LIMITED ENERGY PERMIT FEES:
T,, TWqi� t `�'i.�,. -F!. 4757 °i y �TM' y �' ; �'4��,°�' I ',' J � "'
Fee for all residential systems combined $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑' Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ Building'PamiMELC- PennitApp.doc 04/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection Line: ¢603) 009 -4175 MST
IN ECTION DIVISION Business Line: (503) 639 -4171 f
Received / / Dat Requested AM • t BUP
Location / cc �i 1( w V Suite MEC
Contact Person � Ph ( D ) PLM
Contractor Gen S Ph ( ) C � ' 7 � � SWR
BUILDING Tenant/Owner re ELC
Footing ELC
Foundation
Ftg Drain Access: d d-r3d Li-0
Crawl Drain
Slab Inspection Notes: SIT
Post & Beam
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS PART FAIL
LEC AL
Service
Rough -In
U
ow Voltage
it m
PART FAIL
D Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
SITE ❑ Please call f• r reinspection RE: Unable to inspect — no access
Fire Supply Line
ADA Date // o Ins actor Ext
Approach/Sidewalk / P
Other:
Final DO NOT REMOVE this Inspection rec rd fro,n4he job site.
PASS PART FAIL